Minty Green Medic

Wednesday, 6 March 2013

Another #Ukmeded introduction to a chat post from me. This week's topic is to be National Finals, and I'm hoping to focus a little more on the more moral question of: are they something we should consider, rather than on the practicalities of implementing any such scheme.The medical schools up and down the country each have their own style of teaching medicine, from Glasgow's PBL based system to Imperial's old school core science and clinical years. They have control over how they select their intake of students and what emphasis different elements of medicine are given within their courses and how they assess their students. Ultimately however, their aims must be broadly similar: to produce medical graduates who can work alongside each other across the country performing the same basic job with confidence, skill and safety. And in the more long term, medical graduates with the skills and knowledge to prepare them to progress through the various stages of post graduate training.
The GMC's Tomorrow's Doctors "sets the knowledge, skills and behaviours that medical students learn at UK medical schools: these are the outcomes that new UK graduates must be able to demonstrate" (http://www.gmc-uk.org/education/undergraduate/tomorrows_doctors.asp) The GMC uses a Quality Assurance of Basic Medical Education (QABME) to assess that this minimum standard has been met. However, many foundation doctors do not feel adequately prepared for their first job and there are worries about the consistency in competency of foundation doctors. (http://student.bmj.com/student/view-article.html?id=sbmj.e600)But the ability to be a good doctor is about more than just basic competencies, and I personally believe it is important to be able to compare the quality of medical education between medical schools more formally. It would allow the public, the profession and students ourselves to be reassured that there is not an appreciable difference in the quality of junior doctor produced by different universities. I have met medical students from up and down the country and am lucky enough to count many of these amazing people my friends. I am sure that we would all like the chance to be judged on our own merits rather than our intelligence and ability misrepresented based on assumptions about the universities which we attend. Many people will say, "It's all right for you, you go to Cambridge, you'd do really well. I go to ... university and we couldn't compete". But that attitude is precisely the one I would love to have the data to challenge. I would personally like the opportunity to test myself against my whole cohort of medical students and be given the chance to compare my strengths and weaknesses and how well prepared I have been by my medical school.If all medical schools are aiming to produce the best doctors possible from their intake then surely they too should be keen for the chance to prove the excellence of their students and teaching methods?I am going to leave it there on my own opinions for just now, and suggest a few questions to consider and a few resources for thinking about the issue of national finals in more depth. Resources include current student attitudes to the quality of their education, comparison of the graduates of different medical schools pass rates in post graduate exams, and discussion by the GMC and MSC.Questions to discuss (I can think of loads!): Should we have a national exit exam?Should a national exit exam examine only basic competencies?Should a national exit exam discriminate the quality of medical graduates?Would such an exam give reassurance that the quality of medical graduates from medical schools is comparable?Would such an exam give reassurance that the quality of medical education at different medical schools is comparable?Could such an exam be used for ranking applicants to the Foundation Programme?Would such an exam cause a "teach to the exam" attitude?Would such an exam cause an increase in the average quality of medical graduates?Would such an exam cause an increase in the average quality of medical education?Would such an exam allow for variety of styles to remain across medical schools?Would such an exam improve the preparation of students to later take post graduate exams?Would such an exam reduce the current level of disparity seen between graduates of different medical schools first time pass rates in post graduate exams?Are groups opposed to such proposals because they wish not to be compared in case that comparison is unfavourable?Would differences between medical schools be down to selection procedure or teaching or both?Could the comparisons made as a result of such an exam impact on current efforts to widen access to medicine?Resources in no particular order:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600015/http://pmj.bmj.com/content/early/2012/01/20/postgradmedj-2011-130479http://www.biomedcentral.com/1741-7015/6/5http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2707380/http://www.gmc-uk.org/doctors/plab.asphttp://www.medschools.ac.uk/SiteCollectionDocuments/Final%20Report%20of%20ISFP%20Project%20Group.pdfhttp://www.gmc-uk.org/strategic_proposal_for_assessment.pdf_25397183.pdfhttp://www.gmc-uk.org/QA_Review___Summary_of_workshops.pdf_49775408.pdfhttp://www.gmc-uk.org/Patel_review.pdf_39254211.pdfhttp://www.medschools.ac.uk/AboutUs/Projects/Documents/MSC%20Position%20Paper%20-%20%20National%20Assessment%20for%20Medical%20Undergraduates.pdfhttp://student.bmj.com/student/view-article.html?id=sbmj.e600Massive thanks to my friends @RoseTintdScrubs and Christopher King (who sadly isn't on twitter!) for all their help with collecting the resources and for all the discussion about this issue already!

Friday, 1 February 2013

A little update from the last blog post. Turns out after our excellent and productive #ukmeded chat my blog was passed to someone involved with the VLE at Cambridge. There has been some behind the scenes work going on about redesigning the VLE and a workshop style meeting was set up for yesterday afternoon and having been sent the blog and worked out who I am emailed and invited me specifically. I'll give a full run down on what went on in a sec, but in brief I am very positive about the whole thing now and the engagement by all concerned was great.

We had a whole afternoon 2-5pm, refreshments and lunch galore, and we had 6 students and 4 staff members to really get to the bottom of how to make the whole VLE better and more user friendly. In the discussion we covered a huge number of issues linked to the VLE, learning, course organisation and even student welfare, and it was so refreshing to feel listened to as an equal about my learning.

The students were:
Me a final year (aka stage 3),
Two 5th years (stage 2's) one of whom is the ex clinical society pres and one the current,
Two 4th years (stage 1's) one of whom is the academic and welfare officer for clinsoc
One of the level 2 (a year before graduating) grad entry students who has worked in software development before coming to medicine

The staff were:
One of the Associate Deans, A GP who is in charge of the GP parts of our course and who has taken on the VLE
Two of the curriculum office staff who are involved in administrating the course and specifically content on the VLE
One of the IT staff

We started with a quick presentation about the plan for the afternoon which largely broke into two big sections, sorting out the structure of the VLE and coming up with a better looking front page and by extension a more functional website. But first we did a quick brainstorm on what we didn't like about the current incarnation and came up with a huge list which covered everything from the last blog post and a good few littler niggles as well.

The biggest dislike was that the site with its very flat and illogical hierarchies make the site near impossible to navigate. And that means things get hidden and put in the wrong place and generally lead to my previous ranting. So we needed to work out structure that could address that, and focus on some logical hierarchies. We began with an idea proposed by the Associate Dean that focused on a placement based model as opposed to the placement and speciality confused split we have at the moment. A lot of discussion went into refining the initial idea but we were all very pleased to get rid of the placement/ speciality split and to form some real hierarchies. The students also pushed for the inclusion of what we're calling Longitudinal Learning maps, as we chose to split the provision of that material by placement we wanted somewhere with an overview without duplicating material. We chose to have pages which linked to the material elsewhere and showed as a kind of "map" for the learning for the year. In the end we worked out something that looks like the below:

One of each tab has been expanded to show the principles. What I really like is the hierarchy reflects how our course works and should help to integrate some of the overarching learning into every placement. It might even force some of the placement and speciality directors into thinking about how their things integrate with each placement!

We spent a long time on the structure but once we had worked it out we turned our attention to a functional and attractive front page. We decided to ditch a lot of the elements currently on there, including the calendar, messages and upcoming events as they all have very little functionality currently. It was felt that we wanted a very streamlined front page with simply a button for each stage which would take you into the start of the above hierarchy alongside a couple of other buttons such as to the longitudinal learning maps, to the student welfare info and to some "General" Clinical school official information (we couldn't come up with a good name for that one). We also spoke about having a tool bar at the top of every page which let you return to the stage home and to the general home as well as a menu to the above "general info". We also wanted some indication of where we were in each hierarchy either by the web address or a bar on screen which said something like Stage3> Medicine> Learning resources.

We spent some time at the end discussing some other niggles (including the terrible picture they insist on showing us of ourselves) and a bookmarks tool which is being introduced as a bit of a fix until the big changes come in. It was just going to be rolled out to us but we have persuaded them that for all changes big or small they need to get a group of students to Beta test the new features as the VLE is cluttered with things that could work but just don't. There were things we suggested that can't be done in Moodle's current set up and there were things we suggested that the team had explored if other medical schools were doing.

All in all we came up with some very positive changes for the VLE but the fantastic thing about the whole process was that it was real grass roots development of a system that the student interact with all of the time. I can't help thinking how nice it was to sit down with such a responsive group of staff and I wonder how many of our other med school niggles might be solved if such engagement was the norm, I came away buzzing. Thanks to everyone on the #ukmeded chat for sparking some great discussion and ideas and for passing on the blog and getting me involved!

Thursday, 6 December 2012

Just a quick note as I asked a few weeks ago to talk about Virtual Learning Environments (VLEs) on the popular twitter chat #ukmeded which involves clinicians, students and even some of those responsible for running med school courses in various parts of the Uk. I am driving back from placement tonight to be back for my SJT tomorrow (eeek, and also another rant for another time) so I thought I'd pop some notes together on why I was so desperate to discuss this (read rant about).

In my humble opinion the Cambridge VLE is completely unfit for purpose. I tried taking some screen shots to show you why but as you'll discover from this post they were too complicated to make much sense! Lets discuss the things I'd want from a VLE and why I think the Cambridge one fails on many of them.

1) A clear and informative front page
Here is my one screen shot:

No I have no idea where to start either.

2) My timetables, Placement information, where to go and when to find accomodation keys/my ward/the clinic I'm scheduled for, who I need to talk to locally on placement for this sort of info

Cambridge's system:
Overall placements for the year often are released very late and onto an entirely different university website. They are also on our front page of the VLE but not as an overview of your year (I even had trouble finding out when my holidays were at first!). Each placement in the Stage tab has a set of dates next to it these form a drop down list, click on the right dates and you will see who you are going on placement with. Don't know the right dates? Go to a different website.

Placement info/ joining instructions: Start at home page go >general-> general curriculum info-> Joining instructions->Hospital Info->Pick correct hospital->AHA! Varying levels of info depending on regional admin ( I had to play with VLE to work out how to find this again!)

Timetables: In base hospital- then perhaps if you click on the placement (From stage tab on homepage) and then on timetables if it is available there might be a timetable of clinics (and whether there are allocated or not) and any teaching there is available. Or there might not be.
Or if you are on our Stage 2 Neurology, Rheumatology and Orthopaedics 6 week rotation there will be 16 separate documents with this sort of info which you must integrate and make sure you get everything necessary signed off and taught with no clashes either within your timetable or with other students. Confusing.
In regional: Rely on emails from local admin staff/word of mouth there will be only timetables for Addies students on the VLE.
Communication skills sessions: Curricular themes tab-> communication skills->pick appropriate stage resources tab lots of resources, no indication of when I might have any sessions though...

3) Information about assessments and coursework clearly labelled with dates due and what is expected of me, emails to notify me of such coursework, maybe a list of the things I need to do each term/ each placement

Cambridge system:
If I go to my stage "hub" and click on the assessment tab it appears to be empty- not even any info about finals. There are tabs about Simulator session but no timetable of when my session might be, and about L-SSC's. No mention of the 2 palliative care essays, the team work reflective portfolio piece I was emailed about the other day or the prescribing exam. Last year we only heard by word of mouth about a reflective portfolio piece we had to complete before going on elective on our experience across the year a few weeks before elective.

If I go to general tab on the home page, then to general curriculum info then to assessments and examinations there is the info about finals. Shame thought I didn't have any :(

Those "assignments" you can see on the screen shot- some of them are proper coursework I must electronically submit but most of them are feedback forms.

4) Resources like lecture notes, podcasts, reading lists etc uploaded promptly and to a location I have a hope in hell in finding. Possibly even all downloadable for when on placement with no internet

Cambridge:
Random e.g. Stage 2 Paeds resources, Go Stage 2 tab-> Growth and development placement->
?Integrated teaching tab (nope try again)
-> Related course Paeds-> handouts and documents Aha! There are some of them as documents.
Or Home-> Speciality tab-> Paeds-> handouts and documents
This is one of the better options. I chose it really randomly.
Podcasts are NOT downloadable, nor watchable on hospital library comps. Hmm.

5) A way to find all of the above, quickly and intuitively with no need for wading through the site clicking randomly on links e.g. logical placement of above, a search box

6) Listening and responding to feedback
Not really a website issue more of a med school issue. Feedback over many years about the Cambridge VLE led them to revamp it for a large sum of money from its previous incarnation as ERweb in my 4th year. ERweb had many of the above issues and was less than pretty but had the odd but useful system of page numbers which when one person found something would lead the rest of us to it directly. The VLE is prettier no doubt. One consistent piece of feedback both before and after the revamp was the need for a search function on the website and that was all it would take to transform the system. No-one has any idea why they didn't ask for this in their expensive revamp. They continue to defend its absence by stating how difficult it would be to add one.

Apparently the VLE we have in Cam is one of the best in the country and many other med schools would love to have one like ours. We are very dubious.

Tell me, what do you want from a VLE and how does the VLE you use provide it and the above? Is it just us who are so frustrated by the system?

Wednesday, 1 August 2012

It seems a long time ago since I last wrote, and things are pretty different too- instead of writing from the little internet shack in Raro instead I'm writing this on David's laptop in a hotel room in California.

Our final proper weekend in Raro we finished off our souvenir shopping at the market, and had to do a couple of laps of the market before we were all satisfied we had what we wanted and needed! Sunday saw us finally go on a Lagoon cruise which we had been putting off to do in Aitutaki. While it was one of the most touristy things we did, it was really worth it. Amy thought it was too cold to go for a swim but Ali, Katia and I went snorkelling off the glass-bottomed boat once they had taken us over to the marine reserve. There were hundreds of fish, as they fed them with the carcass of a huge tuna (our lunch had been filleted off earlier). We also found it entertaining to swim under the glass bottom of the boat and have Amy take photos of us. After snorkelling we headed to a little motu (island) in the lagoon for lunch and a show. They showed us how to climb a coconut tree and husk a coconut before bringing me and another girl up to demonstrate how to tie a pareu (sarong). Then it was time for the guys version of the ties and Ali got brought up. Ali ended up with a pair of shorts tied and then got to perform a Haka with the guides-with plenty of them taking the piss out of him!

Then it was time for our last week at the hospital- it was typically quiet! Dawn signed me off and gave me some lovely comments, we had a little med student photo shoot at the hospital sign and then it was all over! Tuesday afternoon we went diving- 6 of us from the hostel, Ali, Kathryn, Ian (an Irish firefighter), Flo (a German who is travelling the world) and Asa (an American who had sailed to Raro from Tahiti). It was lovely to dive without having to do skills and Ian had brought his underwater camera so there are plenty of photos to put up of us under the water. We did two great dives on the reef- the first had a wreck of a boat the company had sunk in the 90s and on that dive we heard whales!

We had a great couple of evenings out in the final week- on Tuesday we went for a BBQ at the Shipwreck beach bar and on Thursday we went for a proper dinner at the Waterline restaurant as a big final night out for Ian who left on Thursday night, Ali who went on Friday and Kathryn, Asa, Flo and I leaving on the Sat.

Our last few days were wet, but it was also the first few days of the celebrations of independance. The parade through town on Friday was full of floats from lots of the outer islands and ministries. Thankfully we avoided being on the Ministry of Health float!

Tuesday, 24 July 2012

And here it is- the final blog post written and posted from Rarotonga. Week 7 will be coming to you from sunny LA!

We had a great week for our penulitmate one on the island. After getting over the disappointment of not going to Aitutaki we booked diving for today and decided to make the most of the time we had left. The weather still wasn't great but we've done plenty with it!

Amy and I went black pearl shopping on Weds and came away with a black pearl pendant each which I am very pleased with. It took us a long time and lots of walking round town but we reckon we got a pretty good deal all in all. Then we rushed home to head out to Coco Putt for the third and final time- this time it was almost completely empty but for us and we took advantage of that, getting the owners to pour us extra strong drinks and dancing around like fools. My team won the mini golf with a minimum of cheating and it is suffice to say that we all felt a bit delicate on Thursday!

Friday saw us finally tackle the cross-island walk. It had been reasonably dry for the few days before but still we were slipping and sliding quite a bit on the steep muddy path. The 6 of us included Ali, Kathryn and I and then Katia a student nurse from Switzerland, Amy the med student from Leeds and Flo a german who is travelling around the world. I really enjoyed myself (apart from being eaten alive by mossies at the waterfall at the end) but then all out childhood holidays involved climbing mountains!

I'll leave the stories from the weekend to tell you next time else I'll run out of time on my internet card!

Tuesday, 17 July 2012

I sit here and can only marvel that I've only got 10 full days left on this island. I've settled into such a nice routine and I've got so used to being here I barely even notice the ubiquitous crowing of the roosters!

Week 5 turned out to be a bit of a wash out! Monday and Tuesday were quiet and nice weather, particularly quiet because the doctors were preparing for their big annual health conference at the end of the week. We went snorkelling (a bit of a let down after diving) and generally pottered about a bit. On Weds the conference started under heavy skies and Amy (the new elective student from Leeds Uni) spent the morning listening to a range of local and Kiwi presenters talk about the obesity crisis and various more and less viable ways of dealing with it. We escaped at lunch time to town where we looked at so many black pearls our heads were in a spin. The black pearls are one of the Cook Islands most prized products, they are produced in the lagoon of Manihiki which is little more than a circular sand bar or atoll in the northern islands supporting around 300 pearl farmers. The pearls are beautiful and range from $10 for a loose oddly shaped, blemished one to many thousands for a perfect large round one. I think I'll buy one before I leave as they are very much part of the islands.

After our grey day on Weds it proceeded to absolutely pour for 12 hours on Thursday (I went and sat in conference for the morning and got soaked through coming home) and pour all afternoon Friday, Saturday and be grey all day Sunday. We entertained ourselves by going to such delights as the little Whale and wildlife museum in town on Friday (1hrs worth of distraction) and watching a huge number of DVDs!

We did head out on Friday night and went for a really yummy dinner at one of the local restaurants in town- lots fo great fish and then some cocktails and dancing. We even ran into the teacher trainees we met doing our diving who were out celebrating their last night on the island. It seems a lot of people are leaving- the body-boarders who had taken over the hostel headed off last night and the NZ uni holidays are over so the hostel is moving back to the international long term travellers again.

Unfortunately Aitutaki is off the cards- we tried this morning for deals one last time but it was simply too expensive to get there in the end. What that means is we're going to do a few things here we thought we couldn't afford instead like another dive trip with Kathryn once she finishes her open water and

Monday, 9 July 2012

Week 4?! How on earth is it week 4 already?! I'm well over half-way now!

Week 4 went really well, though not quite to plan. The plan was to ring on Tuesday morning, get cheap flights and go to Aitutaki that afternoon. Sadly there were no cheap flights left for last week so Aitutaki is on hold untill we can find some (we'll try again today/tomorrow). Instead we had a quiet week up at the hospital- one of the Paeds consultants was over from the specialist Paeds hospital in Aukland (Starship- isn't that a great name for a children's hospital) to do a specialist clinic and give Dr Dawn a second opinion on a few kids. It ended up being quite quiet as lots of people didn't come in to see the specialist, but those who did were sorted out pretty fast. The week was enlightening as it confirmed my suspicions that despite being an excellent doctor, Dawn is limited by having worked only in Pacific Islands and mostly in the Cooks. She is confident enough with things she sees often but unusual things can throw her and it is very hard for her to keep up to date with the fast developing world of Paeds.

Instead of Aitukati Ali and I finished off our Open Water qualification on Thursday afternoon and Friday last week. Sadly one of the girls who had done the first part of the course with us couldn't complete it as she had developed a tummy bug just after the first dives and her friends took her to the hospital suspecting decompression sickness. Of course we had never been at any real risk of DCS but because she couldn't say no to all the things on the medical form any more she couldn't come diving :(. We had an exam, which both Ali and I got 100% on (apparently only the 4th and 5th people the instructor had seen do so in 800-900) and tried not to be too smug about it especially as the two teacher trainees failed to get the 75% pass mark first time. We got two more much longer Open Water dives and saw even more amazing fish, including some practically tame blue trigger fish who follow the dive boats looking to get fed. We even saw some juvenile Eagle Rays in the harbour while we did our 200m swim test. So now we can go diving anywhere in the world down to 18m with just a buddy- terrifying!

Kathryn arrived on Friday evening and has settled in and is enjoying the sunshine after Aukland's winter. We all went to church yesterday which everyone had told us is an experience we had to have, so we put on our Sunday best and headed to the local church to sit in the tourist section at the back. It was packed, and most of the service was in Cook Islands Maori but the singing was incredible- it was as powerful and emotional as I imagine Gospel worship to be and mostly done in Maori. Then they invited us all to lunch in the church hall where we discovered that many of the Ariki ( Tribal Chiefs) were there and being honoured. It was a lot of fun, if a bit bewildering. Friday had been a public holiday for the Ariki and the whole weekend there were events to celebrate- they kept on pressing us to take left overs so we have lots of left over chicken now!!

My desire to do some good is still there, but I'm just not sure how to channel it- I need to discuss with Dawn about some child health leaflets- I get the impression they would be best if they were also in Maori so I'd need someone to translate.